| NPI | 1609221969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0904X (Licence: PA MD483462) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD483462) |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2026-09-24 |