| NPI | 1417953274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G52507) |
| Additional Taxonomies | 2085N0904X (Licence: CA G52507) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2008-02-14 |