| NPI | 1063900496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101026316) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 6805) |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2026-03-04 |