| NPI | 1912968041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G59522) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 031432) |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2020-05-08 |