| NPI | 1164983078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME151737) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 83619) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2025-08-14 |