| NPI | 1700864014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD00017381) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: ID M-12326) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2018-07-13 |