| NPI | 1285838292 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 74945) | 
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MT 50239) | 
| Enumeration Date | 2007-06-13 | 
| Last Update Date | 2024-12-20 |