| NPI | 1891758025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD00044440) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OR 17478) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA G24002) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2008-03-19 |