| NPI | 1972546240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00042505) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD151077) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: HI MD-9933) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2023-08-15 |