| NPI | 1003020637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A89309) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 234684) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2014-07-09 |