| NPI | 1508953555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-9927) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD26653) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T0549) | |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2025-10-10 |