| NPI | 1548351240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G72011) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 30828) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SD 7411) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2021-12-16 |