| NPI | 1619953866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 43445) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R1934) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 54246) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-36293) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 24986) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: HI MD17478) | |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2022-12-13 |