| NPI | 1609898808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 43756) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A80402) |
| 2085B0100X Radiology, Body Imaging (Licence: TN 43756) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2014-06-04 |