| NPI | 1316073661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD20527) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 22601) |
| 174400000X Specialist (Licence: OR 4301059701) | |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2025-12-12 |