| NPI | 1124081138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00026743) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: WA MD00026743) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD00026743) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2016-03-14 |