| NPI | 1528061058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD600005231) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 025011) |
| Enumeration Date | 2005-05-30 |
| Last Update Date | 2026-02-01 |