| NPI | 1265896773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME182034) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 68612) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2026-07-07 |