| NPI | 1043432206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A101742) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CO CDRH.0061385) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2019-08-29 |