| NPI | 1972572592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2025-04194) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 41459) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2026-01-27 |