| NPI | 1689825135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD199646) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA ML60026972) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60479844) | |
| 208600000X Surgery (Licence: WA ML60026972) | |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2021-01-18 |