| NPI | 1053808279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2022049347) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 71250) |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2025-07-22 |