| NPI | 1356468284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00048913) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2007015094) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2003010743) | |
| Enumeration Date | 2007-03-24 |
| Last Update Date | 2008-09-30 |