| NPI | 1508326950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301509357) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 101724) |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2025-12-01 |