| NPI | 1396794350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD 60551281) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 057533) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2016-01-12 |