| NPI | 1417935354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00018446) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-12308) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AK S-6158) | |
| Enumeration Date | 2006-01-01 |
| Last Update Date | 2015-02-06 |