| NPI | 1639142847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 33060) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD60544107) |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2016-11-22 |