| NPI | 1164402483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61519538) |
| Additional Taxonomies | 174400000X Specialist (Licence: MO 110596) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2024-04-17 |