| NPI | 1346477916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A146967) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA 456943) |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2017-02-23 |