| NPI | 1013362375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD487753) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 67472) |
| Enumeration Date | 2016-04-24 |
| Last Update Date | 2026-01-26 |