| NPI | 1841282423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G67540) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC TL31053) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2021-07-27 |