| NPI | 1386806362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: TX Q7725) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61382225) |
| 2085N0700X (Licence: AZ 49163) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2025-12-04 |