| NPI | 1851352173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2019-01982) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 89099) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 34204) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2025-07-14 |