| NPI | 1811422777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 66671) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301509343) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61373789) | |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2025-12-04 |