| NPI | 1063467355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G74076) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 28227) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2022-12-05 |