| NPI | 1427013150 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 58183) | 
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX J2887) | 
| Enumeration Date | 2006-04-18 | 
| Last Update Date | 2025-03-05 |