| NPI | 1932342300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: ID 8471657) |
| Additional Taxonomies | 2085N0700X (Licence: WA MD 60466632) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60466632) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID 8471657) | |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2025-08-20 |