| NPI | 1205464740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 63589) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-54310) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2025-07-28 |