| NPI | 1215930813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C180383) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 15233) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2024-07-23 |