| NPI | 1861029779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 81792-21) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA DO-55597) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 036.179070) | |
| Enumeration Date | 2020-03-23 |
| Last Update Date | 2026-02-27 |