| NPI | 1639144728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: WA MD60953088) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 41697) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60953088) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2021-10-04 |