| NPI | 1760988315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0072506) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 2896) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 16964A) | |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2024-08-02 |