| NPI | 1962483065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 38773) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 36358) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 32897) | |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2025-07-17 |