| NPI | 1336111269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M9536) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G64280) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 180078-1205) | |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2007-08-30 |