| NPI | 1114905007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00043543) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID 12343) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2019-04-17 |