| NPI | 1336520931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61121029) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: MN 73776) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R7248) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 60839) | |
| Enumeration Date | 2015-06-09 |
| Last Update Date | 2024-10-04 |