| NPI | 1801886429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 52493) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G48238) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2012-09-07 |