| NPI | 1760772800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD60667503) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: WA MD60667503) |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2019-09-03 |