| NPI | 1871515734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A48604) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 35041) |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2022-12-15 |