| NPI | 1871619122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD60006965) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OR MD162228) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301082255) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2018-10-23 |