| NPI | 1285160374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 47977) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 64085) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 77426) | |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2025-04-21 |