| NPI | 1750111951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-19568) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: AR E-19568) |
| 2085B0100X Radiology, Body Imaging (Licence: TX BP10087320) | |
| Enumeration Date | 2024-08-03 |
| Last Update Date | 2025-08-19 |