| NPI | 1205104817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S7294) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY C3404) |
| Enumeration Date | 2011-12-09 |
| Last Update Date | 2025-10-30 |