| NPI | 1457812042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A180669) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 18635A) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GU M-2486) | |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2025-09-16 |