| NPI | 1932516556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX V6127) |
| Additional Taxonomies | 2085N0700X (Licence: TX V6127) |
| 2085N0700X (Licence: FL 145654) | |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2025-08-07 |