| NPI | 1578183018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 104593) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX BP10074422) |
| Enumeration Date | 2020-04-24 |
| Last Update Date | 2025-06-03 |