| NPI | 1215933874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G84459) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: CA G84459) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: CA G84459) | |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2015-07-29 |