| NPI | 1528200896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 10010A) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A113645) |
| Enumeration Date | 2009-04-01 |
| Last Update Date | 2017-03-13 |