| NPI | 1407276991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 82257) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R2407) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OS020517) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS19944) | |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2026-06-24 |