| NPI | 1114291457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO CDRH.0056750) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 84932) |
| Enumeration Date | 2012-03-05 |
| Last Update Date | 2026-09-14 |