| NPI | 1699338731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2024-02812) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 64182) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2026-04-16 |