| NPI | 1932146164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD071306L) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 041601) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2025-07-31 |