| NPI | 1801978481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M17536) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD161516) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60353712) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2026-08-17 |