| NPI | 1669679569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA 20A20771) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX P0069) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2023-08-09 |