| NPI | 1023515160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 66594) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 85203-20) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 22188) | |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2025-09-03 |