| NPI | 1700864261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD.MD.00035253) |
| Additional Taxonomies | 2085N0904X (Licence: PA MD455386) |
| 207U00000X Nuclear Medicine (Licence: HI 24396) | |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2026-07-02 |