| NPI | 1891737664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00028931) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: WA MD00028931) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2019-10-09 |