| NPI | 1376530048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00024019) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: WA MD00024019) |
| Enumeration Date | 2005-09-28 |
| Last Update Date | 2015-02-04 |