| NPI | 1114995453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA G81470) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OK 21079) |
| Enumeration Date | 2006-03-11 |
| Last Update Date | 2021-12-13 |