| NPI | 1346669769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX S5761) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A139165) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2023-07-24 |