| NPI | 1184121899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A196712) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2023-01183) |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2024-07-31 |