| NPI | 1669512760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A70188) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L1516) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD000043027) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2021-08-03 |