| NPI | 1679532253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX W0361) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 43265) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2025-12-12 |