| NPI | 1992768352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD17384) |
| Additional Taxonomies | 2085N0700X (Licence: OR MD17384) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 84908) | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2025-12-05 |