| NPI | 1205223765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX W0784) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 88888) |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2025-09-23 |