| NPI | 1255385654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 39551) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-29773) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 22581) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 31038) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: HI MD17592) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2024-03-31 |