| NPI | 1629562582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2024028718) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX V3135) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD219608) | |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2026-02-26 |