| NPI | 1093957037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NM MD2014-1014) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD60463912) |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2019-05-31 |