| NPI | 1013169366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 15263) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60335207) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A112079) | |
| Enumeration Date | 2008-10-17 |
| Last Update Date | 2014-07-02 |