| NPI | 1801822721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD479666) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 320212) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD00043451) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2024-06-07 |