| NPI | 1922594019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2025-01163) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 93888) |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2025-05-07 |