| NPI | 1104275528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 39669) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: SC LL39669) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101273384) | |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2025-07-14 |