| NPI | 1427634104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME168127) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 3020029) |
| Enumeration Date | 2021-03-22 |
| Last Update Date | 2026-09-28 |