| NPI | 1538691373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A157028) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 76610) |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2024-05-01 |