| NPI | 1275153520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME177834) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX W8083) |
| Enumeration Date | 2020-04-16 |
| Last Update Date | 2026-09-21 |