| NPI | 1386685758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA C32664) |
| Additional Taxonomies | 2085N0700X Radiology Neuroradiology (Licence: CA C32664) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2008-08-11 |