| NPI | 1700884491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2003014840) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS10005) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2025-05-30 |