| NPI | 1053489922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD153781) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301081010) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60233594) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2025-09-15 |