| NPI | 1225458839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60979643) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A161128) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2024-01-31 |