| NPI | 1457884785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2022017553) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 05-47455) |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2026-02-06 |