| NPI | 1265798938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 103919) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.206240) |
| Enumeration Date | 2012-04-07 |
| Last Update Date | 2026-04-07 |