| NPI | 1629430376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: TX U2128) |
| Additional Taxonomies | 2085R0001X (Licence: RI MD21500) |
| 2085R0001X (Licence: CA A176205) | |
| 2085R0203X Radiology, Therapeutic Radiology (Licence: NC 1629430376) | |
| 2085R0001X (Licence: NV 24789) | |
| 2085R0001X (Licence: AZ 68275) | |
| 2085R0203X Radiology, Therapeutic Radiology (Licence: CA A176205) | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2026-08-12 |