| NPI | 1790047371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 10628120-1204) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A15523) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2018-11-27 |