| NPI | 1518917392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 44907) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A62495) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2017-01-04 |