| NPI | 1376049676 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U2670) | 
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL MD.39048) | 
| Enumeration Date | 2018-04-04 | 
| Last Update Date | 2025-09-29 |