| NPI | 1639128242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G29713) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A78943) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2021-12-17 |