| NPI | 1235196148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX J9864) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 44917) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2025-0124) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2025-03-10 |