| NPI | 1881630861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M17468) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD25538) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60166423) | |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2026-07-20 |