| NPI | 1437537354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA FE60449492) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: WA FE60449492) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: WA FE60449492) | |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2016-01-21 |