| NPI | 1215975768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00045936) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 27592) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 34202) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 42696) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 53851) | |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2023-08-10 |