| NPI | 1962842989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 56553) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NV 27482) |
| Enumeration Date | 2013-07-05 |
| Last Update Date | 2025-07-30 |