| NPI | 1235549247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042.0014810) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 327184) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 66403-20) | |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2025-03-07 |