| NPI | 1942490065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2018-00475) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 233036) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 76462) | |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2025-05-02 |