| NPI | 1922207026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD0000056643) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: TN MD0000056643) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0073421) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT191630) | |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2022-03-22 |