| NPI | 1679936173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 69911-20) |
| Additional Taxonomies | 2085N0904X (Licence: WI 69911) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2025-09-15 |