| NPI | 1720277130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0203X Radiology, Therapeutic Radiology (Licence: CA G36565) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA G36565) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2014-05-13 |