| NPI | 1740250323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G73914) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 6620) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2018-11-13 |