| NPI | 1720229149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 239847) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 23153) |
| Enumeration Date | 2009-03-14 |
| Last Update Date | 2025-08-05 |