| NPI | 1598414633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 74787) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 23122) |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2026-07-28 |