| NPI | 1760878037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A156657) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D89484) |
| Enumeration Date | 2015-04-13 |
| Last Update Date | 2022-12-22 |