| NPI | 1982641916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 37910) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX TM00078) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.201298) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 25000) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C164149) | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2021-10-13 |