| NPI | 1205246741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101268621) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD484234) |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2026-05-14 |