| NPI | 1750380671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 12261) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WV 12261) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2020-11-05 |