| NPI | 1861490559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 7705) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G86763) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2013-04-03 |