| NPI | 1750595682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A80767) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 13712) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2015-06-23 |