| NPI | 1043429152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 333142) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61564785) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A87385) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2025-02-05 |