| NPI | 1376047803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 294516) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 79144) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2026-04-30 |