| NPI | 1508845579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A95372) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 94800) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2008-07-21 |