| NPI | 1588653075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX H7813) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-45905) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 16098) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2018032239) | |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2024-10-14 |