| NPI | 1902868433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: OR MD210225) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX J2321) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID MC-1523) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 5145) | |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2025-05-15 |