| NPI | 1174558092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 34285) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD00047895) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2021-11-03 |