| NPI | 1932104163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G81736) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-24519) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 114447) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2025-08-22 |