| NPI | 1457597387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C154960) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 69996) |
| Enumeration Date | 2008-12-24 |
| Last Update Date | 2018-06-01 |