| NPI | 1932191590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A60595) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX K4604) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2025-12-10 |