| NPI | 1194141689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 81791) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GU DO-0118) |
| 2085N0700X (Licence: WI 81791-21) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2019-01146) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 1452) | |
| Enumeration Date | 2014-03-09 |
| Last Update Date | 2026-08-12 |