| NPI | 1902831449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 89305) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A95996) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2022-01-24 |