| NPI | 1255313417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-34434) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C143714) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 57142) | |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2020-01-02 |