| NPI | 1376868687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60465026) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 63819) |
| 2085B0100X Radiology, Body Imaging (Licence: WA MD60465026) | |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2016-09-28 |