| NPI | 1770536567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00034822) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 34601) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2011-01-21 |