| NPI | 1497382550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2026-03593) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 1021988) |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2026-07-30 |