| NPI | 1962760371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A130779) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: CA A130779) |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2021-12-17 |