| NPI | 1487073979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301507237) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: WA MD61044567) |
| 2085B0100X Radiology, Body Imaging (Licence: OR MD201416) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD201416) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61044567) | |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2022-09-01 |