| NPI | 1780616557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 5590) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G54188) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2014-09-18 |