| NPI | 1376516021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00040143) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 75626) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2024014718) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-52304) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GU MC-191) | |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2024-08-21 |