| NPI | 1568923340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 86572-20) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 46200) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2026-07-28 |