| NPI | 1992703474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00018498) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX K1887) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD29233) | |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2016-02-01 |