| NPI | 1487858833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 61071) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60135255) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 76659) | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2018-08-20 |