| NPI | 1104117175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0056620) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A136921) |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2019-09-17 |