| NPI | 1124214374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A108694) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 380515-1205) |
| Enumeration Date | 2007-09-21 |
| Last Update Date | 2022-07-05 |