| NPI | 1558520890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60630897) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: NY 268728) |
| 2085B0100X Radiology, Body Imaging (Licence: WA MD60630897) | |
| 2085B0100X Radiology, Body Imaging (Licence: OR MD183983) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD183983) | |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2018-03-17 |