| NPI | 1629374061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 229100) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60359447) |
| 2085N0700X (Licence: MA 229100) | |
| Enumeration Date | 2011-02-02 |
| Last Update Date | 2026-02-23 |