| NPI | 1861631459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD60082442) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 235938) |
| Enumeration Date | 2009-02-05 |
| Last Update Date | 2024-09-03 |