| NPI | 1467660738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A104179) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA R-7828) |
| Enumeration Date | 2007-05-19 |
| Last Update Date | 2021-12-15 |