| NPI | 1104073386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 10237201-1205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.054103) |
| 207U00000X Nuclear Medicine (Licence: UT 10237201-1205) | |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2026-04-28 |