| NPI | 1962474163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60703635) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301089073) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD180766) | |
| 2085N0700X Radiology, Neuroradiology (Licence: MI 4301089073) | |
| 2085N0700X Radiology, Neuroradiology (Licence: OR MD180766) | |
| 2085N0700X Radiology, Neuroradiology (Licence: WA MD60703635) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0063047) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2017-06-29 |