| NPI | 1891710547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: WY 6390A) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: NE 21149) |
| 2085B0100X Radiology, Body Imaging (Licence: CO 37616) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NM TM2012-0809) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 14051) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OH 25.000246) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2022-06-27 |