| NPI | 1063640100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 108424) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 13434) |
| Enumeration Date | 2009-06-28 |
| Last Update Date | 2015-07-20 |