| NPI | 1518123041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60335345) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 5757) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 45752) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: HI MD-23897) | |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2023-09-21 |