| NPI | 1871596502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: WA MD00030322) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: WA MD00030322) |
| Enumeration Date | 2005-05-26 |
| Last Update Date | 2025-10-08 |