| NPI | 1366070328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 77424) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 81981) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 24149) | |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2026-07-07 |