| NPI | 1023070737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60933328) |
| Additional Taxonomies | 2085N0700X (Licence: WA MD60933328) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX K0084) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 21796) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME171251) | |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2025-03-24 |