| NPI | 1568676948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C136522) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX W1543) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 235974) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 16880) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2017042542) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2025-10-13 |