| NPI | 1376981183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 155034) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-52752) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2024-04-12 |