| NPI | 1497092159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61093023) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 28035) |
| Enumeration Date | 2013-01-14 |
| Last Update Date | 2024-11-12 |