| NPI | 1205499688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 75096) |
| Additional Taxonomies | 2085N0700X (Licence: GA 111683) |
| Enumeration Date | 2019-04-21 |
| Last Update Date | 2026-06-10 |