| NPI | 1184665846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 14219404-1235) |
| Additional Taxonomies | 2085N0904X (Licence: TX G0943) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2025-09-12 |