| NPI | 1366493678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: MI 4301504400) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR 24839) |
| 2085N0700X (Licence: WA 61382258) | |
| 2085N0700X (Licence: VA 0101287214) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301504400) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2025-09-24 |