| NPI | 1407871163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD15909) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00025311) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2024-07-05 |