| NPI | 1376648410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A77055) |
| Additional Taxonomies | 2085N0904X Radiology, Nuclear Radiology (Licence: CA A77055) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: CA A77055) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2009-01-20 |