| NPI | 1114580578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0074816) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 18269A) |
| Enumeration Date | 2019-04-20 |
| Last Update Date | 2025-07-14 |