| NPI | 1699302638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61573890) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036178610) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 35.155120) | |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2026-02-17 |