| NPI | 1184039059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 12805646-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A139439) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2022-06-06 |