| NPI | 1801860739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00012473) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD00012473) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2012-09-06 |