| NPI | 1699396549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301511962) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2025-00602) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 76545) | |
| Enumeration Date | 2020-05-01 |
| Last Update Date | 2025-10-06 |