| NPI | 1780903773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: WA MD60610582) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301501561) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60610582) | |
| Enumeration Date | 2010-05-31 |
| Last Update Date | 2025-01-27 |