| NPI | 1295840924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D72707) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA ML20008696) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2017-03-13 |