| NPI | 1114157740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T3972) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101249129) |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2025-03-19 |