| NPI | 1073189155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 67532) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD228750) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD.MD.70079833) | |
| Enumeration Date | 2021-05-31 |
| Last Update Date | 2026-07-31 |