| NPI | 1164635173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A100113) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: CA A100113) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GU MC-207) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 16698C) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-52680) | |
| 208D00000X General Practice (Licence: CA A100113) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2024-08-21 |