| NPI | 1295837292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX N1262) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA G57226) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2016-09-20 |