| NPI | 1538203674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A83124) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: CA A83124) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 66116) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 54630) | |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2021-01-06 |