| NPI | 1437582772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A128288) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 245305) |
| Enumeration Date | 2013-08-09 |
| Last Update Date | 2020-11-13 |