| NPI | 1164984332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0072930) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 2992) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 17856A) | |
| Enumeration Date | 2019-04-04 |
| Last Update Date | 2025-07-03 |