| NPI | 1902894629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200300010) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 056692) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 735) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0102201824) | |
| 2085B0100X Radiology, Body Imaging (Licence: NC 200300010) | |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2025-09-15 |