| NPI | 1255391389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR N7605) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 111843) |
| 2085N0700X (Licence: GA 111843) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2026-05-04 |