| NPI | 1316200900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD467405) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A150015) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2019-06-24 |