| NPI | 1053381079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301108685) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD0029176) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MDE00029176) | |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2015-10-16 |