| NPI | 1689860850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 5763853-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD 60033967) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A103290) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-10369) | |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2023-06-01 |