| NPI | 1104864735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A48601) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD0533141L) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR 180888) | |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2023-08-08 |