| NPI | 1508861287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 22759) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 81489) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2026-05-05 |