| NPI | 1972097863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A183976) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ R77287) |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2025-06-26 |