| NPI | 1679763460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME116104) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A121164) |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2020-01-30 |