| NPI | 1497779961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 04-34084) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-259534) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 4205-320) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2025-07-31 |