| NPI | 1285167932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0904X (Licence: UT 14281397-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 31049) |
| Enumeration Date | 2017-04-10 |
| Last Update Date | 2026-07-22 |