| NPI | 1336703412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 323603) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 94983) |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2026-01-14 |