| NPI | 1619996766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: CA A78343) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD169923) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2023-12-09 |