| NPI | 1790746873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101052191) |
| Additional Taxonomies | 2085N0700X (Licence: TX J3440) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2026-07-20 |