| NPI | 1699125799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD202369) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301502339) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61111659) | |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2026-02-03 |