| NPI | 1902884430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00029473) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: WA MD00029473) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2010-07-12 |