| NPI | 1750366498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A89966) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042-0011216) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.201125) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2021-06-25 |