| NPI | 1134789456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0076468) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 63639) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 37218) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 19369A) | |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2026-07-07 |