| NPI | 1811036619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A80100) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: IA MD-45157) |
| 2085B0100X Radiology, Body Imaging (Licence: CA A80100) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-45157) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2022-03-28 |