| NPI | 1285769059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P2174) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A85198) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2015-08-14 |