| NPI | 1841292620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: ID M-9115) |
| Additional Taxonomies | 2085N0700X (Licence: WA MD61244472) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61244472) | |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2025-08-03 |