| NPI | 1194178673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME168824) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 44248) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 22388) | |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2025-09-10 |