| NPI | 1053571174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD60878020) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: WA MD60878020) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2024-02-27 |