| NPI | 1114582640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T4243) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 341257) |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2025-10-28 |