| NPI | 1588620686 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD423380) | 
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0007493) | 
| Enumeration Date | 2006-04-26 | 
| Last Update Date | 2025-01-28 |