| NPI | 1750602363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q3189) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 2277721) |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2025-09-06 |