| NPI | 1386919652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0066078) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NY 293072) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA A147234) | |
| Enumeration Date | 2012-03-19 |
| Last Update Date | 2021-08-05 |