| NPI | 1801017074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 17096) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 109414) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2025-09-02 |