| NPI | 1770541559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX E1171) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 114157) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2026-04-22 |