| NPI | 1699394486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME173925) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 97785) |
| Enumeration Date | 2020-04-11 |
| Last Update Date | 2026-09-09 |