| NPI | 1497866214 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 14014) | 
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60020673) | 
| Enumeration Date | 2006-08-31 | 
| Last Update Date | 2025-07-16 |