| NPI | 1942648662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2025012292) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0013074) |
| Enumeration Date | 2013-06-05 |
| Last Update Date | 2025-04-29 |