| NPI | 1750846747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61557714) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 32809) |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2026-07-13 |