| NPI | 1619103306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 050084) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 258024) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2026-06-03 |