| NPI | 1861429953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA DO-05903) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA OP00001975) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2021-10-01 |