| NPI | 1699841254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: NV 12398) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD042578L) |
| 2085R0001X (Licence: KY 45674) | |
| 174400000X Specialist (Licence: HI MD10713) | |
| Enumeration Date | 2006-11-27 |
| Last Update Date | 2026-09-30 |