| NPI | 1790135507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A157796) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 26752) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 21955) | |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2025-05-30 |