| NPI | 1497954317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C172351) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AK MEDS7777) |
| 2085N0700X (Licence: WA MD60106629) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-12499) | |
| 2085N0700X (Licence: AK MEDS7777) | |
| 2085N0700X (Licence: ID M-12499) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60106629) | |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2026-06-04 |