| NPI | 1609810902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: WA MD00043911) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: WA MD00043911) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00043911) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2013-12-05 |