| NPI | 1558327593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 110617) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G87478) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2017-12-05 |