| NPI | 1780779892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2022-03033) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60085925) |
| 2085N0904X Radiology, Nuclear Radiology (Licence: OR MD164669) | |
| 2085N0904X Radiology, Nuclear Radiology (Licence: WA MD60085925) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD164669) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2023-07-13 |