| NPI | 1134148034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G163362) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00023747) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 362635) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2024-09-06 |