| NPI | 1255968301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX T9103) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AL 50792) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2025-04-29 |