| NPI | 1366885840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61029376) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: TX R5803) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-51666) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GU MC-162) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 19800) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2023044647) | |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2024-08-19 |