| NPI | 1669440236 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: WI 44018) | 
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 44018) | 
| Enumeration Date | 2006-03-09 | 
| Last Update Date | 2023-04-12 |