| NPI | 1811208143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 1461) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 21936) |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2026-02-05 |