| NPI | 1134239965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD00048126) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA ML20007481) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2017-10-02 |