| NPI | 1528521721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0072985) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 36692) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 17902A) | |
| Enumeration Date | 2019-04-13 |
| Last Update Date | 2025-07-14 |