| NPI | 1366652729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M6592) |
| Additional Taxonomies | 2085N0904X (Licence: TX M6592) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: TX M6592) | |
| 2085N0700X (Licence: TX M6592) | |
| 2085B0100X Radiology, Body Imaging (Licence: TX M6592) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2026-08-05 |