| NPI | 1740458637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 001581) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY C2021) |
| Enumeration Date | 2008-02-14 |
| Last Update Date | 2025-11-13 |