| NPI | 1679504229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA G156779) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IA MD-52547) |
| 2085R0205X Radiology Radiological Physics (Licence: NY 180417) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2024-07-24 |