| NPI | 1215496351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 79458) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A193508) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 85590) | |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2025-07-11 |