| NPI | 1700345741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME172737) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 41811) |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2026-02-08 |