| NPI | 1679809537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61217222) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101281964) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A175532) | |
| Enumeration Date | 2009-10-28 |
| Last Update Date | 2024-07-29 |