| NPI | 1396094652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 82198) |
| Additional Taxonomies | 2085N0700X (Licence: TX R4583) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R4583) | |
| 2085N0700X (Licence: IN 01095802A) | |
| Enumeration Date | 2012-09-02 |
| Last Update Date | 2026-08-06 |