| NPI | 1770519753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: MO 107111) |
| Additional Taxonomies | 2085N0700X (Licence: WA MD00020128) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00020128) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 107111) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2010-05-10 |