| NPI | 1538140207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD00036387) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD00036387) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00036387) | |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2023-03-13 |