| NPI | 1407855786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD26771) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00045665) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M0141) | |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2022-02-04 |