| NPI | 1962769059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 14508) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD228213) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD70061262) | |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2026-03-06 |