| NPI | 1265437727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085U0001X Radiology, Diagnostic Ultrasound (Licence: CA B18861) |
| Additional Taxonomies | 208600000X Surgery (Licence: CA G85951) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2015-09-18 |