| NPI | 1932490703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME172342) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A96935) |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2025-03-26 |