| NPI | 1073199105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 36360) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 56902) |
| Enumeration Date | 2021-03-19 |
| Last Update Date | 2026-07-21 |