| NPI | 1720766025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: AZ R80219) |
| Additional Taxonomies | 2085N0700X (Licence: AZ R80219) |
| 2085N0904X (Licence: AZ R80219) | |
| Enumeration Date | 2023-07-06 |
| Last Update Date | 2025-06-19 |