| NPI | 1326091786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C199487) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 35319) |
| 2085N0904X (Licence: AZ 35319) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2025-07-17 |