| NPI | 1487035812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 77519) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 87005) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2025-09-17 |