| NPI | 1831268457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX E2517) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 40495) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2026-05-29 |