| NPI | 1245621036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 1527) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 13107-321) |
| Enumeration Date | 2015-02-15 |
| Last Update Date | 2025-09-10 |