| NPI | 1336495365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD445338) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A125013) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2016-00833) | |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2025-12-16 |