NPI | 1699396549 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301511962) |
Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2025-00602) |
2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 76545) | |
Enumeration Date | 2020-05-01 |
Last Update Date | 2025-10-06 |