| NPI | 1306865969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 49404) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A119884) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2019-07-05 |