| NPI | 1811355563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 85226) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 30441) |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2026-10-13 |