| NPI | 1295969855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C171646) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC MD39538) |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2024-04-24 |