| NPI | 1033422951 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: CA 20A13403) | 
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 4943) | 
| Enumeration Date | 2010-07-20 | 
| Last Update Date | 2025-07-24 |