| NPI | 1861479081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A69952) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX L4119) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2012-01-05 |