| NPI | 1366428351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A54637) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: ID M-16080) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2022-01-20 |