| NPI | 1285261354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: MA 1022329) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2026-00085) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2026-06-30 |