| NPI | 1780976654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A14515) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA 1780976654) |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2021-12-17 |