| NPI | 1114952165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: CA A34125) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA A34125) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2010-02-03 |