| NPI | 1316982614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: CA A69300) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A69300) |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2019-12-13 |