| NPI | 1821273038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX N8226) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA C142575) |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2016-08-12 |