| NPI | 1518980796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A89996) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 37956) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2018-10-29 |