| NPI | 1619157609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 47172) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 256973) |
| Enumeration Date | 2007-11-07 |
| Last Update Date | 2026-06-03 |