| NPI | 1699303404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2025-01245) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 2025-01245) |
| Enumeration Date | 2020-03-28 |
| Last Update Date | 2026-07-13 |