| NPI | 1083939623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60751693) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 254860) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD184078) | |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2022-10-13 |