| NPI | 1366861841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 53142) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MO 2019009534) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2019009534) | |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2025-04-03 |