| NPI | 1700804739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD051675L) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00041069) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2025-10-22 |