| NPI | 1649430976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 61319) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: WA MD60235444) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2019-05-24 |