| NPI | 1427014117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0904X (Licence: TX G0961) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G36647) |
| 2085N0904X (Licence: CA G36647) | |
| Enumeration Date | 2006-04-22 |
| Last Update Date | 2014-03-05 |