| NPI | 1295239846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T3056) |
| Additional Taxonomies | 2085N0700X (Licence: WA OP61425153) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX BP10067762) | |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2025-05-29 |