| NPI | 1710440821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 83308-20) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2024-00266) |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2025-07-23 |