| NPI | 1700818465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60058168) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR 17405) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2022-05-26 |