| NPI | 1508860438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 19429) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GU MC-235) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2025-06-24 |