| NPI | 1568535300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD00015534) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA 00015534) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2010-01-26 |