| NPI | 1790933570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD439150) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT189090) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A115746) | |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2021-06-28 |