| NPI | 1427507458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OR MD204966) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD61069008) |
| Enumeration Date | 2016-10-03 |
| Last Update Date | 2021-08-24 |