| NPI | 1891737094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 4737479-1205) |
| Additional Taxonomies | 2085N0904X (Licence: UT 4737479-1205) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2026-06-05 |