| NPI | 1629238100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A120948) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 235781) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2023-10-31 |