| NPI | 1124559505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 1922) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 010281) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 76801) | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2025-12-11 |