| NPI | 1851499727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD0000043623) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A102150) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO T2003013850) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2008-09-03 |