| NPI | 1760465728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G32752) |
| Additional Taxonomies | 2085N0700X (Licence: CA G32752) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2007-10-23 |