| NPI | 1174766034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 14291) |
| Additional Taxonomies | 2085N0700X (Licence: CA A120966) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A120966) | |
| 2085N0700X (Licence: NY 251680) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 251680) | |
| 2085N0700X (Licence: NV 14291) | |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2016-02-17 |