| NPI | 1063568335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 34061) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N2044) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2026-03-23 |