| NPI | 1598266884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2023026198) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX W0269) |
| Enumeration Date | 2018-02-22 |
| Last Update Date | 2025-12-12 |