| NPI | 1316050503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD14025) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00029404) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G67966) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2007-07-10 |