| NPI | 1194178673 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME168824) | 
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 44248) | 
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 22388) | |
| Enumeration Date | 2016-07-19 | 
| Last Update Date | 2025-09-10 |