| NPI | 1730202987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 50443) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OT011777) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2025-06-13 |