| NPI | 1871090415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301507064) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 98807) |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2025-09-07 |