| NPI | 1003079112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 57666) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A109484) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2021-07-22 |