| NPI | 1437577723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60952368) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: WA MD60952368) |
| 2085B0100X Radiology, Body Imaging (Licence: WA 60952368) | |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2020-07-01 |