| NPI | 1447925151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2025-02246) |
| Additional Taxonomies | 2085N0700X (Licence: DC MTL2000280) |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2025-11-24 |