| NPI | 1235380825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2024-03242) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P4513) |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2025-07-09 |