| NPI | 1780872564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD00048526) |
| Additional Taxonomies | 207U00000X Nuclear Medicine (Licence: WA MD00048526) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: ID M-12318) | |
| Enumeration Date | 2007-10-05 |
| Last Update Date | 2015-02-09 |