| NPI | 1528093580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: PA MD068700L) |
| Additional Taxonomies | 2085N0700X (Licence: MA 234504) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 234504) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2026-01-15 |