| NPI | 1811198344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0102209896) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 3977) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2026-05-13 |