| NPI | 1306404579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: AZ 61832) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX W7132) |
| 2085N0700X (Licence: TX W7132) | |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2026-09-23 |