| NPI | 1154511756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60105093) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD 60105093) |
| 207Q00000X Family Medicine (Licence: ND 11023) | |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2022-07-21 |