| NPI | 1821042532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G31971) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 79828) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2026-05-04 |