| NPI | 1225094683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G72109) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 15935) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2019-10-11 |