| NPI | 1174642839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 44772) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61385118) |
| Enumeration Date | 2007-03-27 |
| Last Update Date | 2025-12-04 |