| NPI | 1174029870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2023000977) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101284470) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 98439) | |
| Enumeration Date | 2018-04-02 |
| Last Update Date | 2025-09-17 |