| NPI | 1932156064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 33784) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA G31418) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2023-03-10 |