| NPI | 1366535353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: MO 2004017584) |
| Additional Taxonomies | 2085N0904X (Licence: CA A95212) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A95212) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: CA A95212) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2022-08-24 |