| NPI | 1649532557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A155924) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD460551) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2018-08-03 |