| NPI | 1114978210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A86524) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 31066) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2014-07-21 |