| NPI | 1538105077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA G132013) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD051661L) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2024-04-08 |