| NPI | 1831105972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 7202) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G64756) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00024407) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2014-09-18 |