| NPI | 1023035995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085D0003X Radiology, Diagnostic Neuroimaging (Licence: CA C198022) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 782376) |
| 2085N0700X (Licence: NC 200201269) | |
| 2085N0700X (Licence: CA 782376) | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2025-11-14 |