| NPI | 1265876445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 65977) |
| Additional Taxonomies | 2085R0001X (Licence: CA A154299) |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2020-08-12 |