| NPI | 1114975646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA 20A5312) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OK 4372) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2011-03-16 |