| NPI | 1932300613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD000423425) |
| Additional Taxonomies | 2085N0700X Radiology, Neuroradiology (Licence: WA MD000243425) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2015-02-05 |