| NPI | 1073991360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME129954) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A167964) |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2021-08-18 |