| NPI | 1578701827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2022046398) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N3224) |
| 2085B0100X Radiology, Body Imaging (Licence: MO 2022046398) | |
| 2085B0100X Radiology, Body Imaging (Licence: TX N3224) | |
| Enumeration Date | 2009-01-24 |
| Last Update Date | 2023-01-09 |