| NPI | 1104018951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 14294) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 350049) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2026-01-02 |