| NPI | 1124002217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101058501) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD426620) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 226234) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2026-07-01 |