| NPI | 1013207653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C184157) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ME MD21630) |
| Enumeration Date | 2011-04-17 |
| Last Update Date | 2024-04-25 |