| NPI | 1669573838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A68044) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 35081) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2007-07-08 |