| NPI | 1891972212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 14212992-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 99713) |
| Enumeration Date | 2008-01-28 |
| Last Update Date | 2025-05-12 |