| NPI | 1972536365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 44328) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 7421A) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 23588) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 312998) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD4575793) | |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2022-03-22 |