| NPI | 1134680812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 290600) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 24037) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2025-01-09 |