| NPI | 1841713138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME173471) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2024016798) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2026-03-11 |