| NPI | 1225068125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C29553) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 4414) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2017-05-10 |