| NPI | 1821040866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A72116) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD16575) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P3059) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2007-0239) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2023-07-06 |