| NPI | 1356387120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA OP00001925) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M6799) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2020-10-21 |