| NPI | 1043446834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 43010108641) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 60798) |
| Enumeration Date | 2009-06-07 |
| Last Update Date | 2026-07-24 |