| NPI | 1033558143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: WA MD61132280) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: WI 67503) |
| 2085B0100X Radiology, Body Imaging (Licence: WA ML60387848) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA ML60387848) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 67503) | |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2021-07-08 |