| NPI | 1407485014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2024047161) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX V6396) |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2026-09-21 |