| NPI | 1720041031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085N0904X Radiology Nuclear Radiology (Licence: WA MD00017183) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD00017183) |
| Enumeration Date | 2006-04-08 |
| Last Update Date | 2008-06-24 |