| NPI | 1154374718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C-173199) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 212864) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2021-06-25 |