| NPI | 1992144976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO CDRH.0073599) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE CP1051) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 17444C) | |
| Enumeration Date | 2013-06-23 |
| Last Update Date | 2025-01-02 |