| NPI | 1255438693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 52345) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D38482) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2021-08-10 |