| NPI | 1801329149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 37911) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 29816) |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2026-01-15 |