| NPI | 1336127687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 11536452-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 76247) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2025-11-26 |