| NPI | 1619923984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME92811) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 23641) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2025-04-16 |