| NPI | 1801259890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OS021981) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA DO-06675) |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2025-01-22 |