| NPI | 1699888628 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 11729) |
| Additional Taxonomies | 174400000X Specialist (Licence: MS 11729) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2025-01-17 |