| NPI | 1659950277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2026-03524) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U0364) |
| Enumeration Date | 2021-04-02 |
| Last Update Date | 2026-08-31 |