| NPI | 1194721035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G76378) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: CA G76378) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2017-05-31 |