| NPI | 1548216575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA G12333) |
| Additional Taxonomies | 2085N0904X Radiology Nuclear Radiology (Licence: CA G12333) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2018-01-29 |