| NPI | 1750775755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO TL.0006273) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101025292) |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2025-01-14 |