| NPI | 1407819592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 2085B0100X Radiology Body Imaging (Licence: CA A46002) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA G34614) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2007-07-08 |