| NPI | 1467493536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A69106) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 12221) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2020-05-29 |