| NPI | 1629000484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA OP0000896) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: WA OP0000896) |
| 2085N0904X Radiology, Nuclear Radiology (Licence: WA OP0000896) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2023-03-07 |