| NPI | 1720061047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00049252) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: OR MD18920) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2020-01-24 |