| NPI | 1760460240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: WA MD00044170) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00044170) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD00044170) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-12374) | |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2015-02-09 |