| NPI | 1730279399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2025016242) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 42967) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2025-05-14 |