| NPI | 1336777945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 81816-21) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 7336) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2026-07-28 |