| NPI | 1902326804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0070042) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 35454) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 15442A) | |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2023-07-10 |