| NPI | 1750310421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 23679) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 20-23679) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX V2784) | |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2025-08-11 |