| NPI | 1982913794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A121075) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 221703) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 14499) | |
| Enumeration Date | 2010-09-28 |
| Last Update Date | 2020-11-18 |