| NPI | 1063482305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: OR 22942) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 76786) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2026-04-16 |