| NPI | 1649278904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD065024L) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T3273) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101253287) | |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2026-03-18 |