| NPI | 1669911434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U4519) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: TX U4519) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 31535) | |
| 208D00000X General Practice (Licence: NE 31535) | |
| Enumeration Date | 2017-02-14 |
| Last Update Date | 2023-11-08 |