| NPI | 1578899746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 054543) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A 106919) |
| Enumeration Date | 2009-10-23 |
| Last Update Date | 2021-06-21 |