| NPI | 1285783472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2010-01745) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G63756) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2010-09-27 |