| NPI | 1831436591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 36552) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2020-04511) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS14808) | |
| 208D00000X General Practice (Licence: FL UO3382) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL UO3382) | |
| Enumeration Date | 2013-01-14 |
| Last Update Date | 2026-05-08 |