| NPI | 1669055513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4351048087) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 0) |
| Enumeration Date | 2021-04-29 |
| Last Update Date | 2026-05-11 |