| NPI | 1528488673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A193469) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 85553) |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2024-04-15 |