| NPI | 1891374856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR DO226929) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ R3815) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2026-06-29 |