| NPI | 1932487428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2016011583) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 39576) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 1026905) | |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2026-06-04 |