| NPI | 1205213444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: VA 0101272487) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101272487) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 61610) | |
| Enumeration Date | 2015-04-27 |
| Last Update Date | 2026-07-14 |