| NPI | 1396969945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 41866) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.300287) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD456324) | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2026-07-06 |