| NPI | 1194720334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA DO-03412) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A9402) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2020-07-31 |