| NPI | 1871957308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 92095) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A151572) |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2022-08-22 |