| NPI | 1275511461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M8795) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G65453) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2021-04-21 |