| NPI | 1871757005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A102215) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI EMC0005154) |
| Enumeration Date | 2008-07-16 |
| Last Update Date | 2024-06-04 |