| NPI | 1083142368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D99295) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 23783) |
| Enumeration Date | 2017-05-31 |
| Last Update Date | 2025-10-03 |