| NPI | 1164635173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 3992-320) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A100113) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: GU MC-207) | |
| 208D00000X General Practice (Licence: CA A100113) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WY 16698C) | |
| 2085N0700X Radiology Neuroradiology (Licence: CA A100113) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: IA MD-52680) | |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2025-04-29 |