| NPI | 1639254709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MT MED-PHYS-LIC-10429) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MT 10429) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: MT 10429) | |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2025-08-29 |