| NPI | 1356455463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 103346) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 61451) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2025-07-23 |