| NPI | 1063794428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 019428) |
| Additional Taxonomies | 2085N0700X (Licence: PR 019428) |
| Enumeration Date | 2011-09-12 |
| Last Update Date | 2025-09-11 |