| NPI | 1164527495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: WI 81593-20) |
| Additional Taxonomies | 2085N0700X (Licence: WI 100235-875) |
| 2085N0700X (Licence: WA MD00044995) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00044995) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2023-05-26 |