| NPI | 1609949601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00D16031) |
| Additional Taxonomies | 2085N0700X (Licence: WA 00016031) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2010-01-26 |