| NPI | 1083704134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AK MEDS5514) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME67114) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2003-0775) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2026-04-10 |