| NPI | 1861561300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101278121) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G83287) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2023-04-05 |