| NPI | 1801978481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 6851547-1205) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD60353712) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2024-09-16 |