| NPI | 1942863022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 61530) |
| Additional Taxonomies | 208D00000X General Practice (Licence: AZ 61530) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME169624) | |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2025-08-29 |