| NPI | 1841553088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD60837429) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OR MD188795) |
| 2085N0700X Radiology Neuroradiology (Licence: OR MD188795) | |
| 2085N0700X Radiology Neuroradiology (Licence: WA MD60837429) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2017008637) | |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2024-04-25 |