| NPI | 1669736500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61229238) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 11732640-1205) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 225794) | |
| Enumeration Date | 2012-06-26 |
| Last Update Date | 2022-02-18 |