| NPI | 1386610442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-8022) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX V6159) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD222748) | |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2025-09-18 |