| NPI | 1700237880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-15050) |
| Additional Taxonomies | 2085N0700X (Licence: WA MD61024981) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2022-03-17 |