| NPI | 1316944697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 036687) |
| Additional Taxonomies | 174400000X Specialist (Licence: AL 23913) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 20363) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 16259C) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GU MC-185) | |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2024-07-17 |