| NPI | 1710983135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX J0124) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 25252) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2025-04-25 |