| NPI | 1083813844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-17465) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 210518) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2026-07-30 |