| NPI | 1952626244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61262506) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 136844) |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2023-03-29 |