| NPI | 1003011933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00049440) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 23852) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2017-04-12 |