| NPI | 1487604625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 35893) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GU M-2488) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 22126) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 18008C) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2025-09-23 |