| NPI | 1528621828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A196740) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 92840) |
| Enumeration Date | 2019-04-22 |
| Last Update Date | 2024-08-16 |