| NPI | 1346568227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A112341) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.204917) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 240684) | |
| Enumeration Date | 2010-05-17 |
| Last Update Date | 2021-07-14 |