| NPI | 1669653861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A125819) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 56873) |
| Enumeration Date | 2007-11-16 |
| Last Update Date | 2013-12-30 |