| NPI | 1346698040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 53964) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 28006) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2025-08-01 |