| NPI | 1750919882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY TP941) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 73788) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2026-06-01 |