| NPI | 1104056779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 257875) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA 116006) |
| Enumeration Date | 2009-07-17 |
| Last Update Date | 2021-12-15 |