| NPI | 1427052463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00039184) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD22471) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 4179) | |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2012-09-07 |