| NPI | 1417932740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 33721) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C050195) |
| Enumeration Date | 2005-12-09 |
| Last Update Date | 2008-05-12 |