| NPI | 1508905514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 7956662-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-11297) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NM 2005-0267) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2026-04-28 |