| NPI | 1093888091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00023770) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: WA 00023770) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2016-12-22 |