| NPI | 1861460875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SD 0428296) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: SD 0428296) |
| 2085N0700X (Licence: SD 0428296) | |
| 2085N0904X (Licence: SD 0428296) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 4120-320) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: SD 0428296) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2025-07-31 |