| NPI | 1942291554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2006-00749) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 76878) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2026-02-15 |