| NPI | 1861601791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X Radiology, Neuroradiology (Licence: WA MD00048065) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00048065) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2002014051) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR 80245) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2018-08-15 |