| NPI | 1073931101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2017-02214) |
| Additional Taxonomies | 2085N0700X (Licence: NC 2017-02214) |
| Enumeration Date | 2014-04-05 |
| Last Update Date | 2026-08-28 |