| NPI | 1639306129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 258073) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA ML60026977) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60278929) | |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2014-06-25 |