| NPI | 1871102459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: OR PG199923) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD223734) |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2026-02-12 |