| NPI | 1043301047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD417418) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 52640) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2026-02-12 |