| NPI | 1467915017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 51128) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 74056) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC LL84155) | |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2025-06-05 |