| NPI | 1497174411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61079462) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 65850) |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2025-04-08 |