| NPI | 1154559854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 264117) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 26259) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2025-12-16 |