| NPI | 1710902812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME85798) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A64679) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2012-03-06 |