| NPI | 1740253376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TN MD46318) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD00045958) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2020-06-25 |