| NPI | 1083673172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A94258) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2005-00606) |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2021-12-09 |