| NPI | 1770840704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D74202) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A115640) |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2012-06-13 |