| NPI | 1245761204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 02061) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 022210) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2026-07-08 |