| NPI | 1740368695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD.MD.70094151) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0044345) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD16023) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2026-04-07 |