| NPI | 1972502656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00039656) |
| Additional Taxonomies | 2085N0700X (Licence: WA MD00039656) |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2022-11-02 |