| NPI | 1619597457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2022036638) |
| Additional Taxonomies | 2085N0700X (Licence: MO 2022036638) |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2025-07-18 |