| NPI | 1508933227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 43467) |
| Additional Taxonomies | 2085N0700X (Licence: WA MD60623743) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2025-12-12 |