| NPI | 1649292186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00034763) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD213922) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2023-04-17 |