| NPI | 1174572572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: CA A80102) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A80102) |
| 174400000X Specialist (Licence: CA a80102) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0025677) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2025-08-11 |