| NPI | 1215270285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 81063) |
| Additional Taxonomies | 2085N0700X (Licence: WI 81063-20) |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2025-11-03 |