| NPI | 1528090743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A70733) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 4301059915) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2021-06-09 |