| NPI | 1477533396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IN 01082784A) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R0130) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 89399) | |
| 363AM0700X Physician Assistant, Medical (Licence: FL 89399) | |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2023-07-17 |