| NPI | 1932323862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A120621) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 245647) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2021-12-15 |