| NPI | 1114665643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX W2980) |
| Additional Taxonomies | 2085N0700X (Licence: TX W2980) |
| 2085B0100X Radiology, Body Imaging (Licence: TX W2980) | |
| Enumeration Date | 2022-05-24 |
| Last Update Date | 2026-07-22 |