| NPI | 1912941469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA G62613) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA RHL131405) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2010-09-24 |