| NPI | 1578759395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A121549) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 246454) |
| Enumeration Date | 2007-09-16 |
| Last Update Date | 2018-06-14 |