| NPI | 1962480897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00043387) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AK MEDS6002) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-12327) | |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2019-01-08 |