| NPI | 1609292002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA OP61040926) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: WA OP61040926) |
| Enumeration Date | 2014-03-10 |
| Last Update Date | 2021-01-22 |