| NPI | 1043234776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 9800860) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 9800860) |
| 174400000X Specialist (Licence: CO DR-34301) | |
| 174400000X Specialist (Licence: TX F2652) | |
| 174400000X Specialist (Licence: NM 98-253) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2025-09-11 |