| NPI | 1912199779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD445127) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GU MC-250) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 4770-320) | |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2025-08-06 |