| NPI | 1265462980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G76971) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD205061) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2022-06-06 |