| NPI | 1083691877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 36954) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R1028) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 25035) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-36404) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: HI MD17476) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 54255) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2022-12-09 |