| NPI | 1396815569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM 88-229) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX H5937) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2026-03-31 |