| NPI | 1639707490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101289405) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 202500462) |
| Enumeration Date | 2020-03-29 |
| Last Update Date | 2026-06-12 |