| NPI | 1295901221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301518189) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 47152) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2026-09-02 |