| NPI | 1982655809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C52667) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 9397) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2020-02-06 |