| NPI | 1891105482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 51053) |
| Additional Taxonomies | 2085N0700X (Licence: AZ 51053) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 67173) | |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2026-06-05 |