| NPI | 1750470563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2011-00503) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 98947) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2025-08-22 |