| NPI | 1407437866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2025027611) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MO 2025027611) |
| Enumeration Date | 2021-04-17 |
| Last Update Date | 2025-09-30 |