| NPI | 1609499656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID 7871982) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4351047042) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 79100) | |
| Enumeration Date | 2020-05-26 |
| Last Update Date | 2026-01-07 |