| NPI | 1821028705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: RI MD12590) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A83434) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2019-03-29 |