| NPI | 1205286085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0065898) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 14442A) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 2526) | |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2022-07-28 |