| NPI | 1992768022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00017684) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: WA MD00017684) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2009-07-23 |