| NPI | 1063427565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C169351) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00048874) |
| 2085N0700X (Licence: WA MD00048874) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD26706) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2025-10-07 |