| NPI | 1790246965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0072695) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 2902) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 16913A) | |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2024-08-02 |