| NPI | 1093705337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00017852) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AK 1493) |
| 208D00000X General Practice (Licence: WA MD00017825) | |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2017-03-10 |