| NPI | 1912168584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60078769) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD191029) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2024-08-30 |