| NPI | 1174527121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00033869) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-12434) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A00052836) | |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2018-07-17 |