| NPI | 1790744308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00024406) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G046247) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2015-04-01 |