| NPI | 1538368451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 24397) |
| Additional Taxonomies | 2085N0700X (Licence: KS 04-38729) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 74528-20) | |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2025-07-31 |