| NPI | 1700064862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60137928) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A93723) |
| Enumeration Date | 2008-01-31 |
| Last Update Date | 2014-06-04 |