| NPI | 1477829760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301500990) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A146883) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WI 61774) | |
| Enumeration Date | 2012-03-30 |
| Last Update Date | 2022-03-24 |