| NPI | 1679984793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: PA MD470687) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD470687) |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2026-04-03 |