| NPI | 1508824095 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 082151) | 
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 22418) | 
| Enumeration Date | 2006-05-03 | 
| Last Update Date | 2025-05-28 |