| NPI | 1477812873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60665935) |
| Additional Taxonomies | 2085N0700X (Licence: AK 116005) |
| 2085N0700X (Licence: WA MD60665935) | |
| 2085N0700X (Licence: ID M-13632) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AK 116005) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-13632) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301501630) | |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2025-01-30 |