| NPI | 1629537469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0074578) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 36753) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WY 17854A) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 61451) | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2025-07-03 |