| NPI | 1043899487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A24897) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 94-11003) |
| Enumeration Date | 2021-04-05 |
| Last Update Date | 2026-07-13 |