| NPI | 1881671048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G71747) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX K4121) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2011-03-04 |