| NPI | 1316203607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD60852353) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OR MD190332) |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2019-07-22 |