| NPI | 1497741870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60097539) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-12202) |
| Enumeration Date | 2005-09-21 |
| Last Update Date | 2019-02-21 |