| NPI | 1073635835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00013983) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 638915) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 223044) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2007-07-08 |