| NPI | 1376535765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00033709) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD17100) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SD 2684) | |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2013-04-11 |