| NPI | 1255368353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 18476) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G48368) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 10905036-1205) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2021-07-02 |