| NPI | 1497866214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60020673) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 14014) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2016-04-22 |