| NPI | 1366413486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A64029) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR 23637) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 73295) | |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2024-06-19 |