| NPI | 1811935125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 219212) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T4175) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2025-09-17 |