| NPI | 1770518128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00030661) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 15242) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 11520C) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2023-12-29 |