| NPI | 1619972874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 00015207) |
| Additional Taxonomies | 2085N0700X (Licence: TX V5378) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2026-09-23 |