| NPI | 1780616318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A81370) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 230901) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2022-06-27 |