| NPI | 1861952079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0074597) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NM DO2024-0040) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WY 18324A) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NE 3023) | |
| Enumeration Date | 2019-03-22 |
| Last Update Date | 2025-07-03 |