| NPI | 1104807569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A96381) |
| Additional Taxonomies | 2085N0700X (Licence: CA A96381) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2013-10-01 |