| NPI | 1194741652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2003013354) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 4258-320) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2025-07-31 |