| NPI | 1407084643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A114590) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 010125560) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2016-05-16 |