| NPI | 1134177751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2015-00270) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: MO 2024048286) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2026-08-14 |