| NPI | 1952368672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2026-00076) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX J3029) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 27672) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2026-01-22 |