| NPI | 1306898804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 228577) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A90537) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2025-01-15 |