| NPI | 1013300433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: PR 21916) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 105379) |
| Enumeration Date | 2015-03-10 |
| Last Update Date | 2025-10-02 |