| NPI | 1063801678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID OC-0433) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA OP61322937) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR DO219310) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 1539) | |
| Enumeration Date | 2015-01-20 |
| Last Update Date | 2025-04-18 |