| NPI | 1649415308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 37814) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 7903) |
| Enumeration Date | 2008-12-10 |
| Last Update Date | 2024-03-13 |