| NPI | 1245610963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AK 211573) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2025010837) |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2025-06-24 |