| NPI | 1851326557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A91627) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 14175C) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 17984) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2023-12-28 |