| NPI | 1609863240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00038633) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AK 6071) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-12279) | |
| 2085B0100X Radiology, Body Imaging (Licence: WA MD00038633) | |
| 2085N0700X Radiology, Neuroradiology (Licence: WA MD00038633) | |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2019-01-07 |