| NPI | 1427546597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61326872) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA 60856221) |
| Enumeration Date | 2018-04-24 |
| Last Update Date | 2023-05-24 |