| NPI | 1487695789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G12209) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G12209) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2009-03-06 |