| NPI | 1548373608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR OR MD16692) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA WA MD00029244) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2007-07-08 |