| NPI | 1992324651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 65039-20) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 31508) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 70017) | |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2025-08-11 |