| NPI | 1639059249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0203X Radiology, Therapeutic Radiology (Licence: FL TRP917) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: NY 000625) |
| Enumeration Date | 2025-09-04 |
| Last Update Date | 2025-09-04 |