| NPI | 1063613735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M9341) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 37263) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 26184) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA R-6954) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2021-10-08 |