| NPI | 1114488376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 75523) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2024-03405) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2025-03-11 |