| NPI | 1013177344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2022-00758) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: WA MD60294460) |
| 2085B0100X Radiology, Body Imaging (Licence: OR MD191804) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD191804) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60294460) | |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2022-04-29 |