| NPI | 1134565625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 18667) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A135901) |
| Enumeration Date | 2013-05-11 |
| Last Update Date | 2020-10-21 |