| NPI | 1124352612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX v9968) |
| Additional Taxonomies | 2085N0904X (Licence: TX V9968) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D81840) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD047697) | |
| 207R00000X Internal Medicine (Licence: MI 4301094958) | |
| 207U00000X Nuclear Medicine (Licence: TX v9968) | |
| Enumeration Date | 2009-09-30 |
| Last Update Date | 2025-09-23 |