| NPI | 1053346452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2005014017) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 3914-320) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2025-07-31 |