| NPI | 1740806389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2023026932) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2020016151) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 05-53890) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2025-02006) | |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2026-09-02 |