| NPI | 1588651236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00022776) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: WA MD00022776) |
| 207U00000X Nuclear Medicine (Licence: ID M-12217) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-12217) | |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2019-10-10 |