| NPI | 1225206857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A108357) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 80993) |
| Enumeration Date | 2008-02-17 |
| Last Update Date | 2023-07-11 |