| NPI | 1811950231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G81668) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M8721) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2021-06-25 |