| NPI | 1043895691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2026033961) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX T9745) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 85894) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 06392) | |
| Enumeration Date | 2021-03-16 |
| Last Update Date | 2026-08-19 |