| NPI | 1386818516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60367833) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: WA 60367833) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD205146) | |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2024-08-29 |