| NPI | 1487742698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 28884) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX V1837) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: DE C1-0027092) | |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2025-08-14 |