| NPI | 1770766479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA G54442) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME94664) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: GU M001433) | |
| Enumeration Date | 2007-12-17 |
| Last Update Date | 2010-10-25 |