| NPI | 1770984627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: FL ME150799) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A145291) |
| Enumeration Date | 2014-09-10 |
| Last Update Date | 2024-03-05 |