| NPI | 1790759629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00039626) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00039626) |
| 2085N0700X (Licence: WA MD00039626) | |
| 2085N0700X (Licence: AK 109096) | |
| 2085N0700X (Licence: ID M-13472) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AK 109096) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-13472) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2018-05-15 |