| NPI | 1073588778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 41718) |
| Additional Taxonomies | 2085N0700X (Licence: MD D0050174) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0050174) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2025-11-05 |