| NPI | 1053756361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101029115) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 9408058) |
| 2085N0700X (Licence: IA DO-05177) | |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2026-04-03 |