| NPI | 1255320685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI 11928) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 102976) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2025-03-05 |