| NPI | 1629336573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A107824) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2024035870) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GU MC-257) | |
| Enumeration Date | 2012-04-29 |
| Last Update Date | 2024-12-27 |