| NPI | 1609439066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS22276) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 069426) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 76770) | |
| Enumeration Date | 2019-04-20 |
| Last Update Date | 2025-09-08 |