| NPI | 1225014731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: CT 042224) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 213770) |
| 2085N0700X (Licence: MA 213770) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 42224) | |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2026-10-15 |