| NPI | 1447463658 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085N0700X (Licence: VA 0101265478) | 
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101265478) | 
| Enumeration Date | 2007-05-07 | 
| Last Update Date | 2025-02-26 |