| NPI | 1831651355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 79980) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 1018269) |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2025-07-11 |