| NPI | 1902800311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00017398) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD11587) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G30418) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2012-09-11 |