| NPI | 1003853755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00042980) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: WA MD00042980) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2019-07-29 |