| NPI | 1063402519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-3410) |
| Additional Taxonomies | 174400000X Specialist (Licence: AR E3410) |
| 2085N0904X (Licence: AR E-3410) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX V7274) | |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2025-04-03 |