NPI | 1649229451 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G34218) |
Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: CA G34218) |
2085U0001X Radiology, Diagnostic Ultrasound (Licence: CA G34218) | |
Enumeration Date | 2006-05-09 |
Last Update Date | 2011-02-03 |