| NPI | 1538159561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 10560) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 156834) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2026-06-03 |