| NPI | 1679562714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 19926) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G89061) |
| Enumeration Date | 2005-10-20 |
| Last Update Date | 2011-11-10 |