| NPI | 1740857283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV DO3731) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 110679) |
| Enumeration Date | 2021-06-04 |
| Last Update Date | 2026-02-03 |