| NPI | 1538171095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A97304) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00045432) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301080343) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2013-08-13 |