| NPI | 1235103953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00030954) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00030954) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: WA MD00030954) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2018-07-18 |