| NPI | 1235248964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: TX M7409) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: WA MD00046190) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2016-08-15 |